HEALTH INSURANCE WHILE ON WORKERS' COMP IN FLORIDA 

Health Insurance While On Workers’ Comp In Florida 

If you’ve been injured on the job, medical treatment is one of your top priorities. Who will pay for the hospital or doctor’s office visit? Can you use your own health insurance? Do you think you will need to use your health insurance while on workers' compensation in Florida. These are very important questions and ones that you should discuss with your West Palm Beach workers’ compensation lawyer during your free initial consultation. If you are a covered employee and eligible for workers’ compensation benefits, your workers’ comp claim will cover the cost of your medically necessary treatment, related to the work accident.

(The employer/carrier will also pay a portion of your lost wages if you are unable to work or earn less than 80% of your pre-injury wages while working within your restrictions or limitations). Since workers’ compensation is required to provide you with reasonable and medically necessary treatment, you should not have to seek treatment on your own or through your health insurance plan. Also, you should not have to pay anything out of pocket – unless you reach maximum medical improvement (MMI), then there is a $10 copay.

Receiving full workers’ comp coverage for your medical expenses can be difficult. There are often delays in treatment and denials of medically necessary care. However, you should never have to use health insurance when you have a valid workers compensation claim and your injury is work-related.

health insurance claim form

Florida: Health Insurance and Work-Related Injuries: What Employees in Florida Need to Know

In Florida, health insurance is not responsible for and does not cover work-related injuries for employees. This is because the law requires employers to provide medical treatment to the injured worker. If you are a covered employee and have a work-related injury, the employer/carrier must provide you with reasonable and necessary medical treatment. However, there are times that the employer/carrier refuse to authorize medical treatment.

If you are forced to seek medical treatment on an urgent basis or under a self-help scenario, your health insurance may be entitled to reimbursement or subrogation from the work comp insurance carrier. These situations may be difficult and complex so if time allows, it is recommended that you contact a workers’ compensation attorney to discuss prior to unauthorized medical treatment. Once the employer/carrier authorizes medical treatment, use of your health insurance is rarely recommended due to the work comp laws and limitations under the self-help provision and urgent care statute.

It is very possible that your health insurer may deny coverage based on your workers’ compensation eligibility and then you may be personally responsible for the bill.

These scenarios become complicated and to avoid issues with health insurance and workers’ compensation insurance, the best thing you can do is contact an experienced West Palm Beach workers’ compensation attorney to make sure you receive the medical benefits you are legally entitled.

If you have any issues with your health insurance company or workers’ compensation carrier, your work comp attorney will be able to assist you and answer any questions.

Can You Lose Your Health Insurance While On Workers’ Comp?

Injured workers sometimes receive health insurance through their employer. Injured workers that are able to work within their restrictions should not lose their health insurance or any fringe benefits provided to the employee while on workers’ compensation. However, what happens when an injured worker is unable to work? Unfortunately, if the injured worker is unable to work and the employer is unable to keep their job open for months at a time and while the injured worker is out of work, the answer is maybe. The injured employee can request COBRA insurance but the premiums for COBRA can be expensive for an injured worker to pay while only receiving a percentage of their Average Weekly Wage (AWW). If the employee’s health insurance is cancelled, the claimant’s AWW will increase by the amount the employer contributed to the employee’s fringe benefits. So while filing a claim for workers’ compensation benefits won’t cause you to lose your insurance coverage, an injured worker can still lose health insurance coverage while on workers’ comp.
For example, health insurance may be lost if:


You Lie About the Cause of Your Injury – If you lie about the cause of your injury in order to obtain health insurance coverage and do not pursue treatment under workers’ comp, this could result in a loss of coverage.

You Lose Your Job – If you have health insurance through your employer but are unable to continue working after your work accident, although you may be eligible for COBRA insurance, this could result in a loss of coverage.

You Don’t Pay Your Premiums – Even after your injured, health insurance premiums must continue to be paid in order to maintain your health insurance coverage.

If you don’t pay your premiums, your insurance company will likely drop your insurance coverage.


Workers’ compensation insurance will cover your work related conditions, conditions resulting from your work injuries, and unrelated conditions that are a hindrance to the treatment and recovery of your work injuries. If you have questions, an experienced West Palm Beach workers’ compensation lawyer can help you avoid unnecessary issues.

What If I’m Not an Employee?

So far, our discussion has focused on employees. But, what if you are an independent contractor? Under Florida law, independent contractors generally are not eligible for workers’ compensation. However, even if the employer has designated you as an independent contractor, doesn’t mean that you are an independent contractor under the worker’s compensation laws.

If you have a work-related injury and you are an independent contractor, you should be able to use your health insurance—because workers’ compensation benefits aren’t available to you. If you are truly an independent contractor, you may have a personal injury claim and the employer’s workers’ compensation immunity may not apply. It is highly recommended that you speak to a work comp lawyer to discuss whether you qualify as an independent contactor or covered employee.

In some cases, both employees and independent contractors can file personal injury claims for work-related injuries (though there are limitations for employees and third party tort-feasors must be at fault). If you have a personal injury claim, your work comp attorney will be able to help you seek full compensation for all of the financial and non-financial costs of your injury and can recommend a personal injury attorney to assist you.

Making Sure Your Medical Bills Are Covered After a Work-Related Injury

How can you make sure your medical bills are covered after a work-related injury? First, make sure to tell the health care provider that you were injured on the job and while working or at work. Seeking medical treatment for your injury as soon as possible and providing a history of the injury is important. We also recommend talking to a West Palm Beach workers’ compensation attorney about your workers’ compensation rights as soon as possible.

If you are eligible for workers’ compensation, waiting to see an authorized workers’ compensation doctor can be painful.

If you can’t wait and you need urgent or emergent care, or have to treat with your normal primary care physician (PCP), then that should be ok but be sure to let them know how you were injured and ideally, let them know you were injured at work.

If the employer/carrier accepts financial responsibility for your claim (or your employer accepts financial responsibility if your employer is self-insured), your medical treatment costs should be covered and your health insurance can be notified before making any payments that work comp is responsible.

As you can imagine, this is not as easy as it seems and often, it is difficult for an injured worker to deal with on their own. It is best to have an experienced West Palm
Beach workers’ compensation lawyer on your side. You may also be entitled to disability benefits or indemnity benefits paid through workers’ comp. Your work comp lawyer will be able to seek all available forms of financial compensation on your behalf. Dealing with workers’ compensation and health insurance after a work-related injury can be exhausting. Hiring an experienced work comp attorney can help you focus on getting better and protect you and your family by making sure you’re getting the benefits you deserve. There are no out of pocket fees or costs when you hire a work comp attorney.

Contact Us to Speak with a West Palm Beach Workers’ Compensation Attorney

If you were injured on the job and would like assistance with your work accident and want to know more about how to protect yourself when it comes to health insurance and workers’ compensation medical treatment and insurance please let us know. We have been helping injured workers since 1978. Vassallo, Bilotta & Davis are experienced attorneys in West Palm Beach that represent injured workers. Please call us at 561-471-2800 or request a free consultation online today using the "Chat Widget" or Click Here to fill out the request form.